The nations children's hospitals have complained that they get less financial help from the federal government than similar general hospitals that have less need.
Children's hopitals treat more complicated illnesses requiring more intensive care and longer hours of nursing attention than general hospitals of similar size, the group said.
Such hospitals also have higher expenses, but more often provide care free and must wait longer for reimbursements from insurance companies and government agencies, the group added.
Those findings, released in a $350,000 study conducted for the National Association of Children's Hospitals and Related Institutions (HACHRI), demonstrate the "fragile condition" of national financing for child health services and portend "dire consequences" unless solutions are found, the consultants concluded.
Compering a children's hospital with one nearby general hospital of similar bed size in nine major cities, the survey aimed at changing Medicaid and some private insurance plans that roimburse both kinds of hospitals have the same capacity.
"The regulating agencies do not understand the differences in complexity of care" in children's facilities , association president Robert H. Sweeney said. As a result, children's hospitals recover only 93 percent of their costs, while general hospitals in the survey are reimbursed for 100 percent.
The study is also aimed at influencing benefits structures under national health insurance if it is enacted, Sweeney said.
Although children's hospitals now make up the 7 percent cost deficit from donations and endowments, they can expect financial difficulties in the future unless reimbursement rates are altered, association spokesmen predicted.
"Is the purpose of philanthropy to subsidize the federal government?" Sweeney asked. While most of the hospitals surveyed are financially in the black, at least one is operating on short-term borrowing, according to Marvin Bootin, who directed the work of the four consulting firms that prepared the report.
Ned W. Smull, a doctor who reviewed the consultants' findings for the association, said it was not intended to "look like a self-serving study," but hospitals that are members of the 10-year-old organization "were constantly placed on the defensive by insurers - they were comparing us to general hospitals."
In addition to the 41 percent higher rate of intensive care, the consultants found that children's hospitals serve larger geographical areas than general hospitals, employ more registered nurses and fewer orderlies, have more teaching components and shorter patient stays.
Sweeney acknowledged that the general hospitals surveyed are not really equivalent to the children's hospitals because they lack the concentrated support of teaching components. In the Washington area, for example, Children's Hospital National Medical Center, a regional facility, was paired with suburban Montgomery General Hospital. Sweeney said the association did not have the funds to analyze that distinction.